New Onset Diabetes Mellitus After Solid Organ Transplantation

Pham, Phuong‐Thu T.; Pham, Phuong‐Chi T.; Lipshutz, Gerald S.; Wilkinson, Alan H.

doi:10.1016/j.ecl.2007.07.007

Cited by 101 publications

(103 citation statements)

References 49 publications

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“…Fasting blood sugar was obtained at baseline, daily posttransplant for the first 7 days, at weeks 2, 4, 6, 8 and at months 3,6,12,24,36,48,60. The definition of treatment of diabetes was the use of insulin and/or hypoglycemic agents.…”

Section: Methodsmentioning

confidence: 99%

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New-Onset Diabetes After Transplantation:Results From a Double-Blind Early Corticosteroid Withdrawal Trial

Pirsch

Henning

First

et al. 2015

American Journal of Transplantation

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New-onset diabetes after transplantation (NODAT) is an important complication following kidney transplantation. Data from the 5-year early steroid withdrawal double-blind randomized trial were analyzed to determine if steroid avoidance reduced the NODAT risk. Incidence, timing and risk factors for NODAT were evaluated using eight definitions. By American Diabetes Association definition, 36.3% of patients on chronic corticosteroids (CCS) and 35.9% on early corticosteroid withdrawal (CSWD) were diagnosed with NODAT by 5 years. The definition combining fasting blood glucose !126 mg/dL on two occasions or treatment identified slightly more cases of NODAT: CCS (39.3%) and CSWD (39.4%). Through 5 years posttransplant, the proportion of NODAT patients requiring treatment were similar (CSWD 22.5% vs. CCS 21.5%); however, insulin therapy was lower with CSWD (3.7% vs. 11.6%; p ¼ 0.049). By multivariate analysis, only age, but not corticosteroid use, was a significant risk factor for NODAT for more than one definition. Numerical, but not statistically significant trends toward lower NO-DAT rates with CSWD were observed through 5 years for insulin use, HbA1c !6.0% and !6.5% on two occasions. This prospective, randomized trial of CSWD indicates that CSWD has a limited impact in reducing NODAT when compared to low-dose prednisone (5 mg/day from month 6 to 5 years).

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Section: Methodsmentioning

confidence: 99%

“…The incidence of new-onset diabetes mellitus after transplantation (NODAT) ranges from 5% to 50% and is more common in Hispanic and African-American races (1)(2)(3). Additional risk factors include older recipients, obesity and a history of infection with hepatitis C and cytomegalovirus (2,(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

New-Onset Diabetes After Transplantation:Results From a Double-Blind Early Corticosteroid Withdrawal Trial

Pirsch

Henning

First

et al. 2015

American Journal of Transplantation

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“…Currently, almost all classical anti-rejection drugs used in the transplant setting (including, calcineurininhibitors, mTOR inhibitors, and steroids) are toxic to islet cells [36][37][38][39][40]. Their continuous use can lead to loss of islet graft function; post-transplant diabetes is a common outcome, even in subjects not prone to diabetes [41]. The induction of hematopoietic chimerism has additional advantages in patients with T1D, as it can enable restoration of self-tolerance, thereby treating the underlying autoimmunity [20].…”

Section: Bone Marrow Stem Cell Transplantation To Induce Hematopoietimentioning

confidence: 99%

Bone Marrow-Derived Stem Cell Transplantation for the Treatment of Insulin-Dependent Diabetes

Fotino

Ricordi²,

Lauriola

et al. 2010

Rev Diabet Stud

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■ AbstractThe bone marrow is an invaluable source of adult pluripotent stem cells, as it gives rise to hematopoietic stem cells, endothelial progenitor cells, and mesenchymal cells, amongst others. The use of bone marrow-derived stem cell (BMSC) transplantation (BMT) may assist in achieving tissue repair and regeneration, and in modulating immune responses in the context of autoimmunity and transplantation. Ongoing clinical trials are evaluating the effects of BMSC to preserve functional beta-cell mass in subjects with type 1 and type 2 diabetes, and to favor engraftment and survival of transplanted islets. Additional trials are evaluating the impact of BMT (i.e., mesenchymal stem cells) on the progression of diabetes complications. This article reviews the progress in the field of BMSC for the treatment of subjects with insulindependent diabetes, by combining allogeneic islet transplantation with donor-specific BMSC. Clinical data is summarized from pilot studies performed at our research center over the last two decades.

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“…4 Clinically, it has been reported that GVHD prophylaxis with TAC is generally associated with a reduced incidence of acute GVHD compared with CsA. In contrast, hyperglycemia was associated with a higher risk of non-relapse mortality after allogeneic HSCT.…”

mentioning

confidence: 99%

“…[1][2][3] A characteristic feature of this field is the use of calcineurin inhibitors, including tacrolimus (TAC), which may cause hyperglycemia as suggested in organ transplant settings, possibly by decreasing insulin secretion. 4 To evaluate this possibility, we serially monitored fasting glucose levels and serum immunoreactive insulin, and calculated homeostasis model assessment (HOMA)-IR and HOMA-b with the HOMA model 5 as recommended by Wallace et al 6 HOMA-IR reflects insulin resistance and HOMA-b reflects the insulin secretion status. 5 If HOMA-IR increased after the administration of allogeneic HSCT, drugs that reduce insulin resistance, such as metformin or pioglitazone, might theoretically be effective.…”

mentioning

confidence: 99%

Decreased insulin secretion in patients receiving tacrolimus as GVHD prophylaxis after allogeneic hematopoietic SCT

Fuji¹,

Kim²,

Mori³

et al. 2009

Bone Marrow Transplant

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New Onset Diabetes Mellitus After Solid Organ Transplantation

Cited by 101 publications

References 49 publications

New-Onset Diabetes After Transplantation:Results From a Double-Blind Early Corticosteroid Withdrawal Trial

New-Onset Diabetes After Transplantation:Results From a Double-Blind Early Corticosteroid Withdrawal Trial

Bone Marrow-Derived Stem Cell Transplantation for the Treatment of Insulin-Dependent Diabetes

Decreased insulin secretion in patients receiving tacrolimus as GVHD prophylaxis after allogeneic hematopoietic SCT

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